环椎骨折手术讲义.ppt

环椎：位于枕骨下、周围韧带的保护作用，骨折相对发生较少 Sherk HH, Nicholson JT. Fractures of the atlas. J Bone Joint Surg (Am) 1970;52:1017–24 环椎骨折占：所有脊柱骨折的 1–2% 颈椎骨折 2 - 13% 严重的颈痛，但没有神经症状 Scharen S, Jeanneret B. Atlas fractures. Der Orthopade 1999;28(5):385–93. Sherk HH, Nicholson JT. Fractures of the atlas. J Bone Joint Surg (Am) 1970;52:1017–24. 1822 年 Sir Astley Cooper首先描述 Cooper A. A treatise on dislocations, and on fractures of joints. London, United Kingdom, Longman, Hurst Rees, Orme Browne, E. Cox and Son, 1822:542. 1920年Geoffrey Jefferson 报道环椎骨折 Jefferson G. Fracture of the altas vertebra: Report of four cases and a review of those previously reported. Br J Surg. 1920;7:407–422. 发生机制 轴向压力或过伸损伤 Jefferson G. Fracture of the altas vertebra: Report of four cases and a review of those previously reported. Br J Surg. 1920;7:407–422. Punjabi 、Sandler 报道过伸时轻度轴向压力就可以引起寰椎骨折 Punjabi MJD, Sandler A. Cervical spine kinematics and instability, in Clark CR, Ducker TB; Cervical Spine Research Society Editorial Committee (eds): The Cervical Spine. Philadelphia, Lippincott-Raven, 1998:55–57. 分型 单纯前弓骨折 单纯后弓骨折 (最常见) 合并前后弓粉碎性骨折 (Jefferson fracture) 单纯侧块骨折 横突骨折 Levine AM, Edwards CC. Traumatic lesions of the occipitoatlantoaxial complex. Clin Orthop Relat Res. 1989;239: 53–68. 临床表现 外伤病史 枕下颈痛 颈痛或颈部僵硬 无神经症状 辅助检查 标准颈椎正侧位片 颈椎张口位片 Computed tomography (CT) ： 冠状位 、矢状位重建 Magnetic resonance imaging (MRI): 评估横韧带损伤，椎动脉 保守治疗 侧块移位不超过 7 mm ，无旋转不稳定 单纯前弓、后弓骨折 撕脱性骨折 横突骨折 颈围制动 8–12 周 Isolated Fractures of the Atlas in Adults. Guidelines for the management of acute cervical spine and spinal cord injuries. Neurosurgery 2002;50(Suppl. 3):S120–4 (chapter 16) 保守治疗 粉碎性或明显移位的侧块骨折可以先行颈矫形支具或牵引复位，复位后用halo vest固定 Levine AM, Edwards CC. Traumatic lesions of the occipitoatlantoaxial complex. Clin Orthop Relat Res. 1989;239: 53–68. 手术治疗 不稳定 Jefferson 骨折，侧块移位大于 8.1mm提示横韧带损伤 粉碎性Jefferson 骨折 : internal fixation (osteosynthesis), occiput-C1 fusion or C1-C2 fusion. 手术方法 C1-C2 融合： C1 侧块 和 C2 椎弓根钉棒